Provider Demographics
NPI:1891957437
Name:GENTLE DENTAL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GENTLE DENTAL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-522-2122
Mailing Address - Street 1:35270 NANKIN BLVD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7221
Mailing Address - Country:US
Mailing Address - Phone:734-522-2122
Mailing Address - Fax:734-522-2436
Practice Address - Street 1:35270 NANKIN BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7221
Practice Address - Country:US
Practice Address - Phone:734-522-2122
Practice Address - Fax:734-522-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI801179OtherBLUE CROSS BLUE SHEILD